Valoración ecográfica de la dinámica diafragmática en pacientes con enfermedad pulmonar obstructiva crónica tras tratamiento con indacaterol/glicopirronio

Abstract

IntroductionAir trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to the diaphragm losing its usual configuration and thus affects its functionality; said functionality seems to improve after administering bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes after the use of short-acting bronchodilators, but there are no studies that assess these changes with the use of long-acting bronchodilators. Material and methodsThis work is a prospective interventional study with 3months of follow-up that assessed diaphragm motion/thickness by means of CU before and after starting treatment with indacaterol/glycopyrronium 85/43 mcg in patients with COPD and moderate to very severe airway obstruction. ResultsThirty patients were included (56.6% men, mean age: 69.4±6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9±7.1mm and 26.4±8.7mm (p < 0.0001); 42.5±14.1mm and 64.5±25.9mm (p < 0.0001); and 36.5±17.4mm and 46.7±18.5mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). ConclusionsTreatment with indacaterol/glycopyrronium 85/43 mcg every 24hours for 3months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients.